وظيفة منسق الموافقات شاغرة لدى The Clinics في الرياض

We are seeking a detail-oriented and organized Approval Coordinator to join our healthcare team. In this role, you will be responsible for managing and facilitating the medical insurance approval process for outpatients. You will act as the primary liaison between medical practitioners, patients, and insurance companies to ensure timely approvals for procedures, medications, and paramedical services, thereby ensuring a seamless patient experience.

Key Responsibilities
• Insurance Verification: Verify patients' insurance eligibility, benefits, and coverage limits before medical procedures or consultations.
• Pre-Authorization Requests: Prepare, submit, and track pre-authorization and medical approval requests to various insurance companies.
• Documentation Management: Review medical files, diagnoses, and doctors' recommendations to ensure all necessary documentation is accurate and complete before submission.
• Liaison & Communication: Serve as the main point of contact between medical providers (doctors/nurses) and insurance companies to resolve any queries or rejections.
• Dispute & Appeal Handling: Follow up on delayed or denied approvals, gathering additional medical justification from physicians to submit effective appeals.
• Patient Support: Guide patients through their insurance approval status, explaining coverage details, co-payments, or out-of-pocket expenses clearly and empathetically.
• Data Entry: Maintain accurate and up-to-date records of all approval statuses, codes (ICD-10 / CPT), and insurance communications in the clinic’s management system.

Requirements & Qualifications
• Education: Bachelor’s degree or Diploma in Healthcare Administration, Nursing, Medical Coding, or a related field.
• Experience: Minimum of 1-3 years of experience as an Approval Coordinator or Insurance Officer within a hospital or medical center in Saudi Arabia.
• Insurance Knowledge: Deep understanding of the Saudi health insurance market, CCHI regulations, and major insurance provider portals (e.g., Bupa, Tawuniya, Medgulf).
• Medical Terminology: Strong familiarity with medical terminology, diagnostic codes (ICD), and procedure codes.
• Skills: Excellent communication and negotiation skills. High attention to detail with strong problem-solving abilities.
• Languages: Fluency in both English and Arabic (written and spoken) is required.